The document discusses the partograph, a graphical tool for recording cervical dilatation and fetal and maternal conditions during labor. It outlines its history, advantages, principles of plotting, and methods of recording key information about labor. Specific guidelines for monitoring labor progress and conditions warranting use or non-use of the partograph are also provided.

1. PARTOGRAPH
EDGAR A. ULEP, RM, LPT, MSPH
College of Midwifery
Quirino State University – Cabarroguis Campus

2. PARTOGRAPH
 It is a composite graphical recording of cervical dilatation and decent of head
against duration of labor in hours
 It also gives information about fetal and maternal condition that are all recorded
on single sheet of paper

4. HISTORY OF PARTOGRAPH
 E.A Friedman in 1954 provide a foundation basis for development of partograph
on the basis of observation of large number of woman in labor
 After that, the composite picture of labor was reported by Philpott 1972, who
combined details of progress of labor together with the information about fetal
and maternal conditions.

5. ADVANTAGE OF USING PARTOGRAPH
1. A single sheet of paper can provide details necessary information at a glance
2. No need to record labor events repeatedly
3. Gives clear picture of normality and abnormality in labor
4. It can predict deviation from duration of labor. So appropriate steps could be
taken in time
5. It facilitates handover procedure of staffs
6. Save working time of staff against writing labor notes in long hand
7. Educational value for all staff

6. PRINCIPLES OF PLOTTING PARTOGRAPH
 The active phase of labor commence at 4cm cervical dilatation
 The latent phase of labor should not last longer than 8hours
 During active labor, the rate of cervical dilatation should not be slower than
1cm/hour
 A lag time at 4hours between a slowing of labor and the need for intervention is
unlikely to compromises the fetus or the woman and avoid unnecessary
intervention

7. METHOD OF RECORDING PARTOGRAPH
 Patient information:
 Name
 Gravida
 Para
 Hospital number
 Date & time of admission
 Time of raptured membranes

8. METHOD OF RECORDING PARTOGRAPH
FETAL HEART RATE
 The rate of the fetal indicates the state of the fetus inside the uterus.
AMNIOTIC FLUID
 Record the color of amniotic fluid at every vaginal examination:
 I: membranes intact
 C: membranes raptured, clear fluid
 M: meconium-stained fluid
 A: absent
 B: blood-stained fluid

9. CERVICAL DILATATION
 Assessed at every vaginal examination and marked with a cross (X)
 Begin plotting on the partograph at 4cm
 This graph consists of homogenous squares, ten square vertically, each square
indicate once cm of cervical dilatation
 The cross (X) in the graph are joined by a continuous line begin plotting on the
partograph at 4cm
 The climbing tendency of this line normally lies on the left of the middle of the
graph
 Alert line: a line starts at 4cm of cervical dilatation to the point of expected full
dilatation at the rate of 1cm/hr
 Action line: Parallel and 4hours to the right of the alert line

10. DESCENT OF THE HEAD
 This is assessed by abdominal examination before doing vaginal examination
 Refers to the part of the head (divided into 5 parts) palpable above the symphysis
pubis
 Recorded as a circle (O) at every vaginal examination
 Hours: Refers to the time elapsed since onset of active phase of labour
 Time: Record actual time

11. UTERINE CONTRACTION
 Uterine contractions are recorded graphically on the partograph according to
their strength and frequency
 Observation of contraction is made half hour in the active phase
 Palpate the number of contractions in 10mins and their duration in seconds

12. MATERNAL CONDITION
Monitor every 4hours and record the findings:
 BLOOD PRESSURE
 PULSE RATE
 TEMPERATURE
 URINE VOIDED

13. MONITOR MORE FREQUENTLY
 Number of contractions in 10minute period
 Fetal heart rate in 1 full minute
 If a woman is admitted in LATENT PHASE of labor (less than 4 cm dilated) record
only other findings (BP, FHT, etc)
 If she remain in latent phase for the next 8 hours (labor is prolonged) transfer her
to hospital.

14. CONDITIONS THAT DO NOT NEED THE USE OF
PARTOGRAPH
 Antepartum hemorrhage
 Severe pre-eclampsia and eclampsia
 Fetal distress
 Previous cesarean section
 Multiple pregnancy
 Malpresentation
 Very premature baby
 Obvious obstructed labor

15. THANK YOU

16. EXERCISES

17. EXERCISE 1